Family Caregiving Transitions and Sleep among Double- and Triple-Duty Caregivers PROJECT SUMMARY/ABSTRACT Sleep is increasingly recognized as a significant public health issue.1 An estimated 50 to 70 million adults in the US chronically suffer from sleep or wakefulness disorders linked to a rising number of health problems, including heart disease, stroke, diabetes, obesity, cancer, and high blood pressure.1,2 Sleep-related problems can affect all areas of life, one of which is employment. A national survey of American workers found that employed Americans get less sleep than they need to function adequately at work; when they do sleep, workers indicate poor sleep quality.3 Although the implications of sleep disturbances are detrimental for any employee, they are particularly important for healthcare employees given their responsibilities of providing quality care and maintaining patient safety. Yet, healthcare employees commonly experience fatigue and poor sleep quality due to long work hours and exposure to physically and psychologically demanding work tasks.4-6 Additionally, healthcare employees may have caregiving responsibilities at home that interfere with sleep.4,7 In the literature, healthcare workers who provide elder care at home are referred to as double-duty caregivers, an understudied population projected to become more prevalent in the healthcare industry.8-13 Double-duty caregivers are at risk for emotional burnout,12 extreme physical and mental exhaustion,7,10-13 sleep deprivation,7 and work-family conflict.8 Double-duty care studies, however, comprise a small and limited body of research. Conceptually, double-duty care overlooks other family care roles women may be balancing at home, especially the provision of both child care and elder care, or 'sandwiched' care.14 Further, prior research has only been cross-sectional and primarily based on qualitative data, women working outside of the US, and relatively small samples.8-13 The proposed training plan addresses these critical barriers to progress in the field and extends scientific knowledge by using an innovative study design to examine a large, unique sample of women working in nursing homes in the US from the Work, Family and Health Study.15-18 Specifically, this work will draw on existing data to answer new empirical questions and strengthen double-duty care research with the following aims: (1) Conduct a longitudinal examination of how family caregiving role continuity and transitions affect subjective and wrist actigraphic indices of sleep among healthcare employees with child (double-duty child care), elder (double-duty elder care), and sandwiched (triple-duty care) care roles at home, and (2) Perform an in-depth examination of stressful experiences and time use among double- and triple-duty caregivers at the daily level to enhance understanding of how each relates to sleep duration, latency, disturbances, and quality. This work will serve as a strong foundation for a research program committed to the study of double- and triple-duty care and pave the way for future investigation into women who combine formal and informal caregiving roles. Findings from this research will also inform the development of interventions for this specific subgroup of working caregivers as well as optimize interventions for working caregivers more generally.